PACKAGE REQUEST | Foreverinamoment.org

Example of items in package.

These packages are intended to children currently battling cancer.

Request Package Form

First name

Last name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Phone

Name of the hospital your child receives treatment at and the child life workers name or social workers name [phone number for them as well]

When was your child diagnosed with cancer? What type of cancer does your child have.

Your childs first name or nickname

What phase of treatment is your child currently in? Example Induction, Consolidation, Maintenance Ect.

T-shirt size and color for your child we do our best to get the requested color but sometimes thats not possible.

Please upload a CLEAR IMAGE you'd like engraved on a 5x7 piece of wood.

Upload File

Upload supported file (Max 15MB)

Please measure your childs wrist

Do you have a code? Please enter it below if you do

How did you hear about us?

IMPORTANT from May-July packages will be on a waitlist while my own son is currently inpatient recieving a bone marrow transplant sorry for the inconvenience. If your child is on Hospice care and need the hand casting kit quicker please email me as foreverinamomentinc@gmail.com or private message me on instagram or facebook

Thanks for submitting!